Finding Text
Information on the federal program – Assistance Listing Number 93.224/93.527,
Health Center Program Cluster from the U.S. Department of Health and Human
Services, Federal Award No. 6 H80CS00581 for project period March 1, 2024 through
February 28, 2025
Criteria or specific requirement – Health Centers must prepare and apply a sliding fee
discount schedule that incorporates the provisions of 42 CFR 51c.303e through
56.303g to ensure that amounts owed for health center services by eligible patients
are adjusted (discounted) based on the patient’s ability to pay.
Condition – The audit of the major federal program identified errors in the application of
sliding fee adjustments.
Cause – The sliding fee calculation was improperly set up within the Electronic Health
Record System.
Effect or potential effect – Inaccurate application of sliding fee adjustments may result
in potential noncompliance with program requirements.
Questioned costs – Not applicable
Context – Out of a population of 5,510 sliding fee adjustments, a sample of 25
adjustments were tested. Out of the 25 tested, 5 adjustments were incorrectly
calculated based on the Organization’s sliding fee scales and the patient’s sliding fee
application. A non-statistical sampling methodology was used to select the sample.
Identification as a repeat finding, if applicable – Not a repeat finding.
Recommendation – We recommend that the Organization perform a review of the
calculation of the sliding fee adjustments within the Electronic Health Record system
to ensure it is properly set up. Additionally, we recommend that a member of
management with an understanding of the Organization’s billing and sliding fee
policies regularly review a sample of sliding fee adjustments in comparison to the
Organization’s sliding fee policy.
Views of responsible officials and planned corrective actions – The sliding fee
adjustment errors resulted from an error in the set up of the automated adjustment
calculation within the Electronic Health Record system. Management has identified the
error with plans to ensure correction within the system. Further, the Organization will
implement a process to periodically review sliding fee adjustments throughout the year
for accuracy.